Smolenski Stefan, George Nancy M
Wayne State University College of Nursing, Detroit, Michigan.
J Am Assoc Nurse Pract. 2019 Jul;31(7):430-436. doi: 10.1097/JXX.0000000000000183.
Diabetic ketoacidosis (DKA) has largely been considered unique to type 1 diabetes because of the absolute lack of insulin production secondary to beta-cell dysfunction. However, a relatively new diabetes subtype known as ketosis-prone type 2 diabetes mellitus (DM) may also elicit diabetic ketoacidosis. Ketosis-prone type 2 DM shares a similar pathophysiology as type 2 DM, but presents initially with signs and symptoms consistent with type 1 DM. Patients with ketosis-prone type 2 DM often present with elevated glucose levels of 500-700 mg/dl, elevated ketone levels, and elevations in hemoglobin A1C. Unlike DKA seen in type 1 DM, they do not exhibit autoantibodies to beta cells. The similarity with type 1 DM exists in their impaired insulin secretion, which, when combined with extreme insulin resistance, will lead to ketoacidosis. Despite the initial clinical presentation that resembles type 1 DM, patients may not require lifelong insulin and achieve appropriate glycemic control with oral agents. Nurse practitioners must recognize the clinical picture of ketosis-prone type 2 DM and use a multifaceted approach, encouraging dietary changes, increased physical activity, and medication adherence to build the self-management skills of the patient and ultimately decrease the long-term disease burden.
由于β细胞功能障碍导致绝对缺乏胰岛素分泌，糖尿病酮症酸中毒（DKA）在很大程度上被认为是1型糖尿病所特有的。然而，一种相对较新的糖尿病亚型，即易发生酮症的2型糖尿病（DM），也可能引发糖尿病酮症酸中毒。易发生酮症的2型糖尿病与2型糖尿病具有相似的病理生理学，但最初表现出与1型糖尿病一致的体征和症状。易发生酮症的2型糖尿病患者通常血糖水平升高至500 - 700mg/dl，酮体水平升高，糖化血红蛋白（A1C）也升高。与1型糖尿病中所见的糖尿病酮症酸中毒不同，他们不会表现出针对β细胞的自身抗体。其与1型糖尿病的相似之处在于胰岛素分泌受损，当与极端胰岛素抵抗相结合时，会导致酮症酸中毒。尽管最初的临床表现类似于1型糖尿病，但患者可能不需要终身使用胰岛素，通过口服药物即可实现适当的血糖控制。执业护士必须认识到易发生酮症的2型糖尿病的临床表现，并采用多方面的方法，鼓励饮食改变、增加体育活动以及坚持用药，以培养患者的自我管理技能，最终减轻长期疾病负担。
